一项在初级保健中实施数字化、自我管理的家长培训的随机试验：对育儿和儿童行为的影响。
A Randomized Trial of Digitally Delivered, Self-Administered Parent Training in Primary Care: Effects on Parenting and Child Behavior.
机构信息
The Ohio State University, College of Nursing, Columbus, OH.
Rush University College of Nursing, Chicago, IL.
出版信息
J Pediatr. 2021 Apr;231:207-214.e4. doi: 10.1016/j.jpeds.2020.12.016. Epub 2020 Dec 16.
OBJECTIVE
To evaluate the effects of a self-administered, digital behavioral parent training program on parent and child behavior for parents of young children.
STUDY DESIGN
A randomized controlled trial compared ezParent (digital delivery of the evidence-based Chicago Parent Program) with an enhanced usual-care control. Introduction to the study occurred during well-child visits at 4 primary care clinics. In total, 287 parents of children age 2-5 years were randomized to ezParent or the control. Parents responded to surveys evaluating parent behavior, self-efficacy, and stress, and child behavior at baseline, and 3-, 6-, and 12-months postbaseline. Multilevel growth models examined parent and child outcomes for intervention efficacy in intent-to-treat analyses. Secondary moderation analysis explored intervention effects by program use and baseline parenting stress and child behavior problems.
RESULTS
The intervention main effect was not significant for parent and child behaviors. In exploratory moderation analysis, parents in the ezParent condition with greater baseline parenting stress reported less corporal punishment (P = .044); and greater improvement in parental warmth (P = .008), setting limits (P = .026), and proactive parenting (P = .019). Parents reporting greater baseline child behavior problems reported greater improvements in parental warmth (P = .007), setting limits (P = .003), and proactive parenting (P = .010). There were no differences in outcomes based on program usage.
CONCLUSIONS
Results suggest that ezParent as a self-administered behavioral parent training program may not be intense enough for child and parent behavioral change as a universal prevention model. Parents may require different levels of support for completion based on their level of service seeking, family characteristics, risk profile, and motivation for change.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT02723916.
目的
评估自我管理的数字行为家长培训计划对幼儿家长的父母和子女行为的影响。
研究设计
一项随机对照试验比较了 ezParent（基于证据的芝加哥家长计划的数字交付）与增强的常规护理对照组。该研究在 4 家初级保健诊所的儿童常规就诊期间进行了介绍。共有 287 名 2-5 岁儿童的父母被随机分配到 ezParent 或对照组。父母在基线时、基线后 3 个月、6 个月和 12 个月时回答了评估父母行为、自我效能感和压力以及儿童行为的调查。多层次增长模型在意向治疗分析中检查了干预效果的父母和儿童结果。二次调节分析通过基线育儿压力和儿童行为问题探索了干预效果。
结果
干预对父母和子女行为的主要效果不显著。在探索性调节分析中，基线育儿压力较大的 ezParent 条件下的父母报告较少的体罚（P = 0.044）；以及父母温暖（P = 0.008）、设定限制（P = 0.026）和积极育儿（P = 0.019）的改善更大。报告基线儿童行为问题更大的父母报告在父母温暖（P = 0.007）、设定限制（P = 0.003）和积极育儿（P = 0.010）方面有更大的改善。基于程序使用情况，结果没有差异。
结论
结果表明，ezParent 作为一种自我管理的行为家长培训计划，作为一种普遍预防模式，可能不足以促进儿童和家长的行为改变。根据他们寻求服务的程度、家庭特征、风险状况和改变的动机，父母可能需要不同程度的支持才能完成。
试验注册
Clinicaltrials.gov：NCT02723916。
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